Concussion Testing Is Flawed, But It's Not The Real Problem

Photo credit: Gregory Shamus/Getty Images
Photo credit: Gregory Shamus/Getty Images

The Wall Street Journal published a devastating story today about Kenney Bui, a high school football player in Washington state who died two years ago at age 17, days after a collision in a game caused him to lose consciousness on the sideline. What distinguishes Bui’s death—aside from the obvious—is that he had sustained another concussion just one month earlier and was cleared to play again, even after a commonly used cognitive evaluation seemed to indicate his brain was healed.


Separately but similarly, SB Nation is out with a deep dive that details how easy it is for NFL players to game the concussion evaluations they’re given under the guise of the league’s protocol.

The takeaways from both pieces is that the testing used to evaluate and understand concussions is inadequate and still evolving. And that no amount of precaution can keep traumatic brain injury from being inherent to the game of football.

The Journal’s Matthew Futterman interviewed Michael McCrea, who is part of a team of researchers that has used brain scans to make a preliminary determination (i.e., still subject to peer review) that there may be a gap between the symptoms evident in a diagnostic evaluation versus those present in a biological test. From the Journal:

McCrea said the early findings show that the biological symptoms of an injured brain last significantly longer than the clinical signals that health professionals gauge through symptoms and cognitive testing. That finding is crucial because scientists know that after an initial concussion there is a ​time of heightened danger when athletes face a major risk of significant injury or even death if they experience another head trauma.

By all indications, officials at Bui’s high school followed every established procedure for diagnosing his brain injury and later clearing him to play. This included the use of a concussion test that the Food and Drug Administration last year approved under what Futterman described as “a classification that requires the presentation of reams of clinical data to support claims of reliability and safety.” Bui was initially cleared to practice two weeks after his first concussion, and the test—developed by a California-based company that uses mental exercises to establish a baseline, against which post-concussion results are compared—determined his brain was functioning as well as it had before the season. But it may not have been completely healed.

“Ultimately,” McCrea told the Journal, “we want to know not only when the athlete is recovered but when his or her brain is safe and ready to play.”


Futterman’s story ultimately poses two questions: Will MRIs and brain scans someday be required to evaluate every player, from the NFL on down, who sustains a concussion? And at the high school level, where there are plenty of budgetary constraints, would that even be feasible?

SB Nation’s story, written by Louis Bien, tackles this subject from the other end of the process: the difficulties in diagnosing brain injuries in the first place. The NFL’s concussion protocol has undoubtedly been a step forward, but the league’s culture of machismo and the tenuous roster status of many players both have a way of forcing those players into doing all they can to remain on the field.


Bien quoted former NFL safety Husain Abdullah, who said that while he never tried to fake his way through the test, he and his teammates did know the screening questions they’d be asked:

“Passing the concussion test was cake because I already knew everything. And they go back through the same thing. He’d ask me the date. He would ask me who was the vice president. He would ask me to count backwards by seven from 100. The first time it’s like, ‘OK, by seven backwards. OK. Yeah, 100, 93, 86 — ’”


Bien also talked to a former NFL fullback and special teamer who declined to give his name because that player is party to the class-action concussion lawsuit against the league. That player—who told Bien “[t]he back end of the NFL is just a nasty place, man”—went on to explain how he beat the protocol and later was able to play two-and-a-half quarters he never remembered, because a teammate wrote all his assignments on his glove.

Bien later cited what happened to Dolphins quarterback Matt Moore during a playoff game in January. After a nasty hit from Steelers linebacker Bud Dupree, Moore was evaluated as the protocol intended before quickly returning to action. Why? Here’s Bien:

The NFL found that the Dolphins failed to follow protocol 
but didn’t punish the team, determining that though the Dolphins “did not recognize that Mr. Moore presented a documented symptom, bleeding from the mouth … There is no indication that competitive issues had an impact on the care that Mr. Moore received.” Essentially, it couldn’t determine that the Dolphins had intended to do anything wrong.


And that’s the issue. Even when everyone involved is well-intentioned and competent, there may be no fix here, no way to make everything okay. The real problem with head injuries in football is football.

[Wall Street Journal]
[SB Nation]